Policies and Procedures 2017-2018

BTI Policies & Procedures 2017-2018 1

Nova Southeastern University

Family Therapy Clinic

Brief Therapy Institute

Policies and Procedures

2017-2018

Mission Statement: The Brief Therapy Institute (BTI), in the Family Therapy Department of NSU’s graduate

College of Arts, Humanities, and Social Sciences (CAHSS), provides family therapy students with on-the-job

professional development in best practices of brief, relational therapy. This training fulfills BTI’s educational

mandate to help students refine therapeutic skills by delivering high quality mental health services to individuals,

couples, and families in the university’s local community, particularly to under-served populations.

The Brief Therapy Staff:

Director: Arlene Brett Gordon, Ph.D., LMFT

Responsible for the management and operations of the Brief Therapy Institute

Contact information:

Phone: (office) 954- 262-3032

(cell) 954-873-7876

Email: [email protected]

Office: Maltz Room 1082

Office Manager: Francesca Angiuli

Responsible for the daily operations at BTI

Contact information:

Phone: 954- 262-3031

Email: [email protected]


Graduate Assistants:

Support the daily functions of the clinic such as intakes, filing, student and client

contact.

Phone: 954-262-3030

Front Office: Maltz Room 1017

Department Chair: Martha Gonzalez Marquez, Ph.D., LMFT

Phone: 954-262-3056


Open Door Policy: We, like you, value a friendly, respectful work environment. Please come to us with your

questions or concerns. You can offer feedback in person or by telephone or e-mail. If you prefer to remain

anonymous, put a note under the office door.

Important Numbers:

Nova Alert: 954-262-8999

Abuse Hotline: 1-800-96-ABUSE


Family Therapy Clinic at the Brief Therapy Institute

Policies and Procedures

Table of Contents

Page

Preparation for Practicum and Initial Sessions 3

Professionalism in BTI 4

Communication with BTI Office 5

First Practicum Session 5

Client Contact 6

Phone Contact with Clients 6

Scheduling Clients 7

Client Sessions 9

Fees and Receipts 12

Closing and Transferring Cases 13

Contact with Larger Systems 14

Request for Documents 14

DVDs and Digital Recordings 16

Clinical Portfolio 17

Supervision and Seeing Clients Outside of Practicum 17

Research and Testing 18

Reporting Abuse, Neglect, or Abandonment 18

Safety and Emergencies 19

Risk of Harm 20

Appendices

List of BTI Documents 23

Case File Format 26

Sample Letters (3) 27

Sample Clinical Summary 30


Preparation for Practicum and Initial Sessions

1. All therapists at BTI must be currently registered CAHSS students to be covered by NSU’s

professional liability insurance policy

HIPAA: All BTI therapists and staff must complete NSU’s HIPAA training using

Blackboard or the alternative method on the Student Resource site. When you have passed

the course, print off a copy of your certificate of completion.

Provide your practicum supervisor with a copy.

2. Course work. Students must have successfully completed the following classes.

SFTM 5310 – Introduction to System Theory

SFTM 5320 – Introduction to Marital and Family Therapy (or the equivalent)

SFTM 6340 – Legal, Ethical, and Professional Issues or the equivalent.

3. Background Checks: In order to work with clients such as minor children and the elderly,

all students are required to have a background check. This information must be on file with

the Family Therapy Department Program office. Please contact Internship Coordinator

regarding any questions about the background check process.

4. Voice Mail: You must have a working voice mail system that you check daily.

5. NSU ID: When in BTI or when participating with any BTI related services, faculty and

students must always wear your NSU Identification for safety purposes. This is a

mandatory, university-wide policy and if you are not wearing the appropriate identification

you may be asked to vacate the premises.

6. Policies & Procedures: 2017-2018 Revised is available online at the following two

locations: Blackboard on the Brief Therapy Institute site and on CAHSS homepage under

Student Resources.

Print a copy of this manual and bring it to each practicum class.

During the second week of practicum, students will be given a copy of Policies &

Procedures Quiz to take individually or as a group.

a. Please complete and return it to their practicum supervisor.

7. Practicum Evaluations: All therapists registered in internal practicum 2, 3, or 4; or external

practicum must provide their new supervisor with copies of their practicum evaluations from

all previous semesters in the program.

8. Independent Doctoral Clinicians

Prior to your seeing your first client of the trimester:

a. Please download current copy of Policies & Procedures (see above #6).

b. Afterward, students must sign a copy of the Policies & Procedures Agreement

which states that you have read and are familiar with Polices & Procedures. This

document can be found in the BTI office.

c. Updated NSU ID badges will be verified at the beginning of each term.

d. Each student is to complete the appropriate Policies & Procedures Quiz by the

second week of the term.

e. The signed Policies and Procedures Agreement and Quiz turn it into the BTI office.

f. Supervision is required for every 15 hours of face-to-face therapy provided. Please

contact Dr. Gordon to schedule supervision sessions at (954) 262-3032.

g. If a client cancels or postpones an appointment, immediately contact the BTI

office. This information may release a room for another student to use.

Record on blue Phone Log in client’s file.


Professionalism in BTI

9. Each term, during your initial practicum meeting, you will be asked to sign BTI’s Disclosure

of Guiding Principle. This document is consistent with the inclusionary principles that

guide the Department of Family Therapy, as well as, Nova Southeastern University. This

document can be found on the BTI Blackboard site.

10. No laptops or phones are allowed during practicum and clinical sessions (except with

permission from the director). This is a potential HIPAA violation.

Use of phones is prohibited during practicum sessions.

Students will be given time to access their phones outside the observation rooms during

breaks.

Students using their phones during sessions will be asked to put them away immediately.

Students can provide family members with the BTI Office number (954-262-3030) in case

of emergency.

11. Attire. The way you present yourself should reflect your professional role as a therapist. If

your clients pay more attention to the way you look than to what you are saying, then you’ll

undermine your credibility and potentially offend, distract, or arouse your clients.

If you are dressed inappropriately you may not be able to see your client for that session.

Please follow these guidelines whenever you are at BTI, regardless of whether you have a

client scheduled:

If you are a woman, you should make sure that your dresses and blouses are professionally

appropriate and do not expose your cleavage or midriff. When sitting, your dresses or skirts

should not expose your thighs.

If you are a man, you should wear shirts with a collar. Ties are optional. Short pants are not

acceptable.

NSU identification badge must be worn in the clinic.

12. Conduct. Be sure your conduct at BTI matches your appropriate attire. Whenever you are in

the building, you should speak and act in accordance with your professional role.

Please do not have personal phone conversations in the hallways, in the BTI office or near

work areas.

Arrive at least 15 minutes before your scheduled practicum or client. If the practicum

observation room is in use, please wait in the student lounge or in the lobby until the room

is available.

Students are not to use phones or personal items located in the clinic’s cubicle areas. They

are the workstations for CPS and CAHSS staff. Please use the phones in the therapy suites

or in the Therapists’ Workroom (1030E).

13. Punctuality.

Parking on campus can be very challenging at times. Please give yourself enough time to

find space.

If you are in an afternoon practicum, you must be at BTI by 2:45 p.m. or by 8:45 a.m. for

a day practicum. If you are seeing client’s independent of the practicum team, you must

arrive at BTI at least 15 minutes prior to your scheduled appointments.

Independent doctoral students who are late or are a no-show will be required to meet with

the clinic director to discuss continuation of their independent case load.

If you leave a confirmation-of-appointment message for your clients and they do not call

back, do not assume that they are not coming. Unless you know for sure that they are

canceling, assume, as you make other scheduling decisions, that they will be attending

their session, and arrive at BTI in time for a supervisory pre-session, unless other

arrangements with the supervisor have been made.


14. Food. We understand that practicum’s run through the lunch or dinner hour. It is most

important not to use the observation rooms as a dining room.

Please bring only non-messy snacks such as sandwiches and salads.

Take-out deliveries to BTI practicums are not allowed.

If your practicum wants to share a meal, schedule time between sessions and eat in the

student lounge.

Food and food by-products must be disposed of in the student lounge area garbage pails.

Communication with BTI Office

15. The BTI office has an open door policy and welcomes questions and concerns about your

clinical experience. Please be respectful and patient with staff on the phone. They are

working with client on intakes and answering questions. BTI staff members will give you

their attention as soon as possible.

16. Please do not use cell phones when in the BTI office.

17. We encourage you to contact the BTI staff (954-262-3030) with any questions and concerns

you might have in reference to your clients and/or the clinic. If no one answers because we

are busy with other calls, please leave a message and someone will return your call.

18. All BTI documents are available in the BTI office.

19. Notes from the BTI Office. Sometimes you will find a memo on or a case file audit in your

client’s file requesting you to complete something correctly. Please work closely with your

practicum supervisor to address these requests. Contact the office manager at BTI (954-262-

3031) if you have any additional questions.

20. BTI staff will be auditing files on a regular basis to ensure that the file documentation

is in the correct order. If you find an audit form in your client’s file, please make the

requested corrections. Both the therapist’s and supervisor’s signature are requested. Please

place the form back into the file for the BTI office staff to review.

First Practicum Session

21. Review Policies & Procedures which can be located at the following two locations:

Blackboard on the Brief Therapy Institute site and on CAHSS homepage under Student

Resources

22. It is imperative that faculty and students have read the most curren edition of the document

and are familiar enough with its contents that they will use it as a reference for clinical work

at BTI.

23. Documents collected by practicum supervisor

The Faculty Practicum Checklist is found in each practicum binder and is used by faculty

supervisors to record information collected from each practicum student:

Student Name

NSU Badge

HIPAA Certificate to be collected at the first session and placed in the practicum’s

binder.

Contact Information form is to be completed and returned in the practicum binder to

provide the BTI Office with your contact information.

Disclosure of Guiding Principles is to be signed and returned in the practicum binder at

the first session of each term.

Previous Evaluations (if second, third and fourth practicum)

24. Also collected during the practicum term

Policies & Procedures forms- affidavit stating students have read and understand the

most current edition of P&P. This document is to be signed, collected and placed in the

practicum binder by the second practicum meeting.


Policies & Procedures Quiz- is collected and reviewed in practicum.

25. Relational Suicide Assessment (RSA)- This item is not to be checked off until after the

practicum has reviewed and discussed

The Relational Suicide Assessment Workshop by Dr. Douglas Flemons is available

online under Student Resources, Clinical Information at:

https://sharkmedia.nova.edu/media/Dept.+Family+Therapy+Training/1_lnp3x86h

It is recommended that students either view on their own or as a group during practicum

down times between client sessions.

RSA should be part of practicum discussions, especially when a client presents at risk of

self-harm or harm to others.

All self-harm assessments must be documented on the RSA document form found in BTI.

If you are having difficulty locating the workshop, please contact Francesca at (954) 262-

3031.

Attendance at the RSA workshop when made available fulfills this responsibility.

Client Contact

26. Intake process. We provide our callers with a full explanation of our services so that clients

have full disclosure. (Occasionally we do have walk-ins and we take their information at that

time).

Clients contact the BTI office requesting services.

Staff completes the BTI Phone Intake form to gather basic demographic information and a

brief explanation as to why they will be coming to therapy.

Clients are informed that as part of a graduate school program, they will be working with

therapists training to earn their graduate degree.

Clients are offered the option of working with a team or independent doctoral clinicians.

Clients make the determination about teams and video recordings during the intake

process.

Clients are informed that if children under the age of 18 are going to be present during

therapy, BTI requires the signature of both biological parents.

Fees are determined based on income using a sliding scale. Our first sessions are free.

If there is third party involvement, additional paperwork (i.e. court documents, Treatment

Consent Affidavit, restraining order) is usually obtained by the BTI staff prior to the first

session.

*Please advise BTI staff if information about third party involvement is mentioned during

the therapy session, but the appropriate documentation is not in the file.

Initial appointments are scheduled and therapists are contacted.

Phone Contact with Clients

27. Initial Contact. BTI staff will call you when they have assigned you new clients. If you are

not available when they phone, call them back so you can get the clients’ names and phone

numbers.

Make sure you contact the clients before the first appointment, let them know that you will

be their therapist, and double check that they have good directions to BTI.

If the practicum supervisor wants to wait to assign the case until the practicum meets, he or

she must then list his or her own name and phone number on the appointment form and

take responsibility for confirming the session 24 hours in advance.



28. Calls to Clients. To help maintain professional boundaries, you must not give your clients

your home or cell phone numbers or your e-mail address.

When calling clients from a personal phone, punch *67 before dialing their number—this

will prevent your number from coming up on their caller-ID. If they do not accept blocked

(*67) calls, phone them on another non-personal line.

You may use phones in BTI therapy suites or room 1030E (Therapists’ Workroom).

Alternatively, you may call BTI at (954) 262-3030 from your phone and have the office

staff make a conference call to the clients; this will allow you to talk to your clients, while

the BTI number appears on their caller-ID.

Phone calls should be limited to 5-10 minutes.

All phone contact must be recorded on the blue Phone/Contact Log form and kept in the

clients’ file.

29. Voice Mail. When you receive a call from BTI, you must return it the same day or first thing

the next business day. If you are called and your voicemail is not working, we will contact

your supervisor directly.

30. Appointment Confirmation. Every week, you must confirm your appointments with your

clients 24 hours in advance. This is good practice and likely increases retention.

Record confirmation phone calls on the blue Phone/Contact Log. Initial each entry.

If you have appointments scheduled on a Monday, call your clients the previous Friday.

For quality assurance, a BTI staff member may follow-up calls with clients who no-show

or make last-minute cancellations.

If the appointment is cancelled or rescheduled, please notify BTI staff (954-262-3030).

31. Confidential Phone Identification. When you make a confirmation call use the number

proceeded with the asterisk (*) on the intake form. Identify yourself as calling from Nova

Southeastern University, not the Family Therapy Clinic or BTI. To help ensure

confidentiality, avoid leaving a message unless you have documentation on the intake form

(or information from the clients themselves) that this is okay. If you do leave a message,

either on voicemail or with a person, only give your name and the BTI phone number.

32. Email Contact. Email is not a confidential means of communication. It is the policy of

NSU in compliance with HIPAA policy that individuals may not exchange clinically

relevant information with clients via email, regardless of any authorization provided by

clients.

If you receive an email from a client, you are responsible to notify the client that the clinic

does not communicate clinical information by email and that the client should call BTI to

contact you directly or to schedule an appointment. The purpose of this practice is to

protect our clients because confidentiality over the internet can not be guaranteed.

When communicating with your supervisor and/or fellow therapists using email do not use

identifying client information, as this is a HIPAA violation.

The BTI office may need to email you with pertinent information, please provide the office

with your Nova email address.

Scheduling Clients

33. Scheduling Appointment. Communication with the BTI office is extremely important.

Please advise us of any changes in appointment time and/or cancellation as soon as possible.

In Practicum. Use the Practicum Appointment Form (day or evening) appropriate

appointment tracking form to schedule subsequent appointments with existing clients, as

well as to request new clients. This is done with your practicum supervisor.

Independent Doctoral Clinicians. If you are scheduling clients outside of a practicum, do

not use the practicum form; instead, indicate openings on the BTI Individual Student


Appointment Schedule form. Return this form to the intake mailbox in the front office one

week in advance (must be turned in by Thursday of the previous week). This is to prevent

double booking of therapy rooms. For each opening you are requesting, include: the

therapist’s first and last name, phone number, client’s first and last name, and type of client

(family, couple or individual).

o Schedule appointments by the hour (not the half hour). This keeps all our rooms

on an hourly schedule.

o The more openings you provide, the more cases you are likely to be assigned.

34. Appointment Change. Please let the BTI office know immediately if your clients cancel an

appointment, if you have cancelled an appointment, if you are unable to make an

appointment, or if you are running late. The BTI office will inform your supervisor.

35. Treatment Consent Affidavit (to replace Therapy Agreement under the following

conditions). Whether biological parents are unmarried, married, separated, or divorced, both

must consent to their children being seen in therapy at BTI, regardless of who has custody:

If one of the parents is able to produce a court order stipulating that the children are to be

seen in therapy or,

If during the process of therapy with a parent, it is determined that the child should attend a

session, a notarized Treatment Consent Affidavit must be completed prior to that

session. Please redirect to the BTI staff so that they may follow-up. Otherwise, treatment at

BTI cannot commence without both parents having signed the form.

36. Court Ordered Cases. When clients are court ordered to attend therapy, we do not

schedule their first session until they have sent us—via mail, fax, or hand delivery—a copy

of the court order. Once the office manager has reviewed the documentation, a staff member

schedules a first session for the adults.

We do not allow children to attend the first session of court-ordered cases.

If you are assigned a court-ordered case, make sure you read the documentation prior

to meeting with the clients, and alert your supervisor. The two of you must conduct a

pre-session prior to the first appointment.

Review all the documents to insure that you have authorization to contact third parties

attached to the court-order: BTI’s Authorization for Use or Disclosure of Information

form or comparable authorization.

37. Guests. No one may bring a guest behind the mirror to observe a session (or a videotape of

a session) without first getting approval from the BTI Director. Requests to bring a guest

must be submitted, in writing, to the front office at least one week in advance of the potential

visit. Approval will not be given for guests who are not mental health professionals. If

approval is given, the person hosting the guest must then obtain prior clearance from the

supervisor and team. Guests who are approved by the director and the team will be required

to sign a confidentiality contract.

38. Term and Holiday Breaks. BTI is a year round community service provider. BTI and

the Family Therapy Department expect you to schedule clients not only during the term, but

also between terms (during term and holiday breaks). When you take on new clients, you,

like any other professional family therapist, will be responsible for providing therapy until

their problem is resolved and/or the case is closed, or, with supervisor and director approval,

until they are transferred to another therapist.

Supervision during breaks will be arranged by the Department and the BTI office.

If either you or your client cancel a session, you must immediately inform the BTI office,

so that we can advise the scheduled supervisor.


Client Sessions

39. Case Assignment Documents. Therapists will receive the BTI Phone Intake prior to initial

session.

40. Client Files:

If you are in a practicum, your supervisor will pick up materials necessary for that class

including client files, DVDs and portable hard drives in the front office prior to the

commencement of the practicum.

If you are not in practicum, or you are but you need a file or DVD for a client who is not

being seen at the moment, you may check them out from the front office.

a. Please check out materials such as files and/or DVDs with BTI staff.

b. After use and prior to leaving the building, return materials to BTI staff to be

checked-in.

c. Make certain to fill out the “sign-out and sign-in” sheets located in BTI.

No client-related information may leave the building. If by accident this should occur,

contact the BTI office immediately.

Removal of client information in the form of notes and DVDs is a violation of HIPAA

policy and a Privacy Incident Form will be sent to the Compliance Office as per

university policy.

41. Client File Documents. Follow the Case File Format guide in the appendix. The following

documents must be in each file for your initial session:

Therapy Agreements: There are a set of four agreement documents. Documents listed her

as 1 and 2 must be signed for clients to be seen at BTI. Documents 3 and 4 are not

mandatory, but preferred

1. Therapy Agreement (or Therapy Consent Affidavit): Mandatory

Must be signed by all clients over 18 prior to the initiation of therapy. This document

explains HIPAA and the Family Therapy Clinic’s policies.

2. Authorization for Audio/Visual Recording and Observation for Supervisory

Purposes: Mandatory.

Must be signed by all clients over 18 prior to thin initiation of therapy.

This document authorizes supervision, either live or video, for the case.

3. Authorization for Use or Disclosure of Information for Inside Educational and

Related Purposes: Clients sign to authorize that the video materials may be shown in

classrooms within the Maltz Building. This is not mandatory, but preferred.

4. Authorization for Use or Disclosure of Information for Outside Educational

and Related Purposes: Clients sign this document to authorize that the video

materials of their session may be used for educational purposes such as conferences,

journal articles, books. This is not mandatory, but preferred.

BTI Client Information: filled out by clients in the lobby prior to the first session.

Session Notes- Initial Session: a vanilla colored document for the first session.

Phone/Contact Log: on-going blue document to record any phone contact with clients

and/or permitted third parties. Cancellations and no shows are also documented on this

form.

Case specific documents such as court documents, etc.


42. Client notes should be completed during practicum. For students seeing clients independent

of practicum, please complete notes in the observation room or in the Therapist’s

Workroom, room 1030E.

43. Greeting Clients. The front office will call your team’s observation room when your clients

arrive for their appointment. When you come to the waiting room to meet your clients,

please introduce yourself and inform them that they will be walking through the clinic to the

assigned room.

If your clients come early or if the team is running late, come out to the waiting room to

greet the clients, help them feel welcome, and let them know when their session will start.

No children under the age of 12 can be left unattended in the waiting area.

44. Therapy Agreement Documents. Once you have escorted your clients into the therapy

room for the first appointment, be sure that you review the Therapy Agreement and

Authorization for Supervision with them before beginning the session.

Before therapy or videotaping can begin, all participants over 18, whether or not they are

family members, must sign the:

a. Family Therapy Agreement

b. Authorization for Supervision

The video recording cannot be started until there is confirmation that all adults have signed

and no one has any concerns.

New Participants: If new participants join subsequent sessions, be sure to go over the

Therapy Agreement and the Authorization for Supervision with them and obtain their

signatures prior to beginning.

a. Prior to a new participant attending the session, the therapist should explicitly ask

the current clients, what, if any, information from previous sessions can be shared

with the new participant.

b. Therapist must concur with the supervisor about the new participant.

45. Videotaping

In practicum: If there is any part of the therapy agreement that your clients do not want to

authorize (e.g., videotaping; use of a team), respond to their concerns non-defensively and

draw a line through the relevant sentences in the agreement.

The clients will then need to initial the deletion(s). Any alterations must be approved by

the supervisor prior to proceeding with the session.

With the approval of your supervisor, you may choose not to videotape, but if the clients

object to the team, let them know that their case will have to go back to the BTI office.

Staff will assign them a therapist who works without live supervision.

Independent Doctoral Clinicians must videotape their sessions. If the clients object to the

videotaping, let them know that their case will have to go back to the BTI office for

assignment to a practicum team.

46. Clients Viewing Sessions. If your clients ask to view a session, they may do so with the

following conditions:

The viewing must take place on BTI premises.

You must be with them during the viewing.

DVD’s must be signed out of the clinic office.

BTI will charge them their usual fee for every hour spent watching the DVD.

47. Confidentiality. Ensure that not only your clients, but also that you understand Florida law

regarding confidentiality and its limits. If you have questions, ask your supervisor and/or any

BTI staff person.

If parents wish to sit behind the mirror and observe while the therapist works with their

children, they may do so, providing that the supervisor is comfortable with this


arrangement. The children are told in advance that this may happen and are informed each

time their parents are behind the mirror.

Sometimes, parents wish to be kept informed of what their children say to the therapist

when the parents are not in the session. When you see children alone for part or all of a

therapy session, let the parents know in advance that you will only break confidentiality

when the law requires it (i.e., when you hear reports of abuse of a minor or elder, or reports

of the client or someone else being in imminent life-threatening danger) and/or when the

safety of the children is at stake.

48. Organize Sessions. Your sessions at BTI must begin and end on time. Organize your

sessions to last approximately 50 minutes. This will ensure that your therapy room is freed

up for the next appointment and will give you time to collect the fee, finalize the DVD,

process paperwork, schedule subsequent meetings, return phone calls, etc.

49. Practicum Breaks. When you (or you and your practicum team) leave your observation

room (whether for a break or because practicum is ending earlier than scheduled), you must

notify the front office before you leave and you must ensure that the staff have a way of

reaching you during the time you were originally scheduled to be on site.

50. Session Notes

Note Entries: All progress-note entries must be written legibly in blue ink.

Contents of Session Notes: Use the BTI Session Note form. If, for some reason, you’ve

left blank spaces, neatly cross them out with a single straight line. You may request

assistance from your supervisor and team to complete this document.

Three formats:

a. Session Notes- Initial Session: a vanilla colored document for the first session.

b. Session Notes- Ongoing Sessions: a white document for ongoing sessions.

c. Session Notes- Closing Session: a lilac document for the final session.

Supervisor Review. Progress notes must be completed within 24 hours of your session.

Supervisors are responsible for quality control. Make sure your supervisor closely reads,

comments on, and signs your progress notes after each session.

When you make corrections in your notes, neatly cross through what you are deleting and

initial the change.

Cancellations and no-shows must be recorded in the Phone/Contact Log.

51. Telephone Contact. Every telephone contact you have with your clients (including the

weekly confirmation calls you make 24 hours in advance of appointments), or with other

professionals regarding your clients, must be noted on the blue Phone/Contact Log

(including date, time, and information). Please date and initial each entry.

52. Client Surveys: Please note that the BTI office will distribute a Client Satisfaction Survey

to all clients at approximately 5-session intervals. Please encourage your clients to complete

this brief survey. Invite the client to place the completed survey in the “BTI Survey Box”

mounted next to the BTI window.

53. Missed Appointments. We recommend the following scheduling guidelines for supervisors

and teams who are working with clients who miss one or more appointments.

Review our cancellation policy with your clients:

Clients who miss their appointment should be rescheduled within the same practicum

when:

They gave at least 24 hours notice of their cancellation.

The therapist failed to call to confirm the missed session 24 hours in advance.

The therapist could not reach the clients to confirm the missed session.

The missed session was the clients’ first session.


Clients who miss their appointment should not be rescheduled within the same practicum

(and their file should be given back to BTI) when:

They no-show or cancel sessions two or more times in a row.

They have no-showed or canceled a total of three sessions.

54. Late Evening Sessions. The Family Therapy Clinic closes at 9:00, Monday- Thursday.

Please schedule clients so you can finish up your case notes and leave at 9:30 p.m. If

circumstances with your clients warrant continuing your last session beyond 9:00 p.m., you

should plan to be finished in time for you and your clients to leave the building by 9:30 p.m.

If circumstances with your clients require your continuing your session beyond 9:30, you

must alert the BTI office. If you are not able to finish your case notes by 9:30, you’ll need to

return the next day to complete them.

55. Record Clinical and Supervision Hours. Any questions about this documentation should

be referred to Trish Turner at 954-262-3072 or [email protected].

Students are responsible for keeping a record of the client contact hours on the Client

Contact Hours Sheet.

Students are responsible for keeping a record of the supervision they receive on the

Supervision Hours Sheet.

At the end of practicum, students complete the forms and have the practicum supervisor

initial for that session.

Independent clinicians are responsible for recording their hours and having their

supervisor sign both the Client Contact and Supervision Hours Sheets after each scheduled

supervision session.

56. Closing Evening Practicum. BTI is very busy, so please make sure to leave the observation

room the way you would like to find it if you were in the next day practicum.

Place trash outside the room.

Be sure that the room is free of crumbs.

Therapy rooms should be neat and ready for the next client.

Shut off lamps, monitor and lights in both the observation and therapy rooms.

If you move chairs from the outer area into the observation room during practicum, return

the chairs to their original location.

Lock the doors to both the observation and therapy rooms.

Please return the practicum bag. This will notify BTI staff that your practicum is leaving

for the evening.

Fees and Receipts

57. Collecting Fees. Fees are expected at the time services are rendered. You need to be

proactive during this final step of your meeting.

At the end of your session, escort your clients to the Family Therapy Clinic window, check

to confirm the fee, assist office staff in collecting the fee.

To ensure confidentiality, please do not open the front window if the staff person is on the

phone. Wait for them to finish with the call.

Wait for office staff to record payment and provide two receipts. One receipt is for the

client and one receipt is to be two-hole punched and placed on the left side of the client

file.

If payment is made using a check, make sure that it is payable to NSU.

BTI Appointment Card: Fill-in your clients’ next scheduled session on back of the BTI

appointment cards at the window sill.


58. Fee Rate. The rate is determined by a sliding scale. The BTI staff sets the fee for clients

after reviewing financial information with them during the intake process. First sessions are

free.

Please note that services to veterans and their family members are free of cost.

59. Fee Reduction:

To request a fee change for your clients, submit a Fee Change Form, signed by your

supervisor, to the BTI office

Be sure to note the amount of the requested.

Our minimum fee is $15.00; however, in special circumstances please review with the

Office Manager.

Inform your client that the fee reduction will be in place for five sessions.

Reoccurring Fee Reductions: If it is necessary to extend the fee reduction for another five

sessions, another Fee Change Form must be signed by your supervisor and submitted to the

BIT Office.

Closing and Transferring Cases

60. Transferring clients (practicum): Scheduling clients for transition to a new practicum team

or another therapist is a collaborative effort between the clients, student and the supervisor.

This conversation should occur at least two weeks before the end of the practicum. Clients

continuing to receive therapeutic services in the following semester will either:

a. Remain with their current therapist and be scheduled based on the student’s new

practicum time.

b. Remain with their scheduled time and the case will be transferred to another

practicum team and therapist.

c. Be transferred to a doctoral therapist working independently of practicum.

The BTI staff will work with each practicum to develop the Client Transfer/Transition

Form designed to inform BTI of the status of your case.

Supervision during breaks will be provided by either practicum faculty or Supervisor

Candidates.

61. During the break, students will need to schedule their clients individually by using the BTI

Individual Student Appointment Schedule. Return this form to the intake mailbox in the

front office. For the opening you are requesting, include: the therapist’s first and last name,

phone number, client’s first and last name, and type of client (family, couple or individual).

Please note if supervision is needed.

62. Closing a Case. The decision to close a case must be made in close consultation with your

supervisor, who will then assist you in broaching and discussing the issue with your clients.

Prior to returning the file to the front office, review it with your supervisor, making sure it is

up-to-date, organized properly, and complete.

Progress notes for the final session should be recorded on the lilac-colored Progress

Notes-Closing document.

The file should include all necessary signatures, documentation for all cancellations or no

shows, and notes for any telephone contact.

Place a sticky note (found in practicum bag) marked “Close Case” on the file and place in

practicum notebook. At the end of the practicum session, the notebook and carrying case

must be returned to the BTI office and given to a BTI staff member.


Contact with Larger Systems

63. Disclosure of Information. You must involve the BTI director and office manager in any

disclosure of client information.

64. Prior to Contact. All contact with larger systems (e.g., agencies, ChildNet, the court

system, lawyers, BSO) should only be initiated after consultation with your supervisor and

with the knowledge of the BTI office staff.

65. Phone Contact.

If another professional calls BTI, asking to speak with you about a client, you must return

the call within 24 hours of his or her contacting BTI (if only to say that without a signed

release from your clients, you can not speak with him or her).

Before calling back, consult with your supervisor. If you cannot reach him or her in time to

meet the 24-hour deadline, alert the office staff and they will put you in touch with the BTI

director or the office manager.

If you do not have an authorization to speak with the professional about a client, you will,

in consultation with your supervisor and/or the BTI director or office manager, call back to

inform him or her that you lack the necessary authorization to confirm that you have a

client by that name, but that you will be happy to speak with them once an authorization is

provided to you.

66. Authorization for Use or Disclosure of Information. Before you can reveal any

information about your clients (including the disclosure that they are clients) to anyone

outside of BTI (except for an CAHSS clinical supervisor or an CAHSS family therapy

class), your clients must complete and sign our release form, the Authorization for Use or

Disclosure of Information.

Comparable Authorization: If other professionals—doctors, mental health practitioners,

government agency workers, lawyers—provide you with a comparable authorization that

your clients have signed for them, you do not also need to get a BTI form signed.

However, the authorization form, whether ours or theirs, must be attached to the left side of

the client file.

Clients living locally, who are requesting their records or a summary must appear at BTI in

person, sign our Authorization for Use or Disclosure of Information form, and present

photo ID. A photocopy of the ID and the Authorization form are then to be placed in the

file, along with a case note documenting that the information was released to the client.

Clients living too far away to make their request in person may do so with the assistance of

a notary. See the office manager for details.

Request for Documents BTI generates two distinct written documents: Letters and Clinical Summaries.

67. Letters: If you are required to write a letter for a judge, lawyer, client, etc., confirm that an

Authorization for Use or Disclosure of Information is signed and in the client’s file. See

sample letters on pages 26-28 for guidance in formatting only. Each letter is to be client

specific.

Then, using the appropriate letter as a template and in consultation with the supervisor,

compose your correspondence. Please note that the template is only a guide and should not

be copied directly. Add information specific to your client’s individual case.

Complete it at least a week before you need it, and submit it, on disk or flash drive, to the

office manager. Please make certain that you have not included any client specific

identifying information. This information will be added in by the office manager. She will

format the letter, get it approved by the director, and print it off on letterhead. You cannot

submit these letters to the office manager as e-mail attachments, as this does not

adequately protect client confidentiality.


Once the letter has been printed and approved, the office manager will erase the file from

your disk or flash drive.

Sign your name with your highest-earned degree and designate yourself as a “Family

Therapy Graduate Student.” Below this, list your supervisor’s name, degree, and

designation, and arrange for him or her to closely read and countersign the letter before it

is sent out:

Sincerely,

[4 spaces]

Student’s Name, Degree.

Family Therapy Graduate Student

[4 spaces]

Supervisor’s Name, Degree

Supervisor

In keeping with Florida Statute 456.057(4), BTI responds to requests for records in the following ways:

68. Clinical Summary.

Clients or clients’ legal representatives who request psychotherapeutic records are given a

Clinical Summary in lieu of copies of the records themselves.

Upon a client’s written request, BTI furnishes complete copies of psychotherapeutic

records to subsequent treating psychiatrists and/or psychotherapists.

Florida Statute 61.13 stipulates that non-custodial parents have rights of access to their

children’s medical records and information, unless a court order specifically restricts such

rights. When a non-custodial parent requests records or information about his or her minor

children, BTI requires that the request be presented in writing and in person, along with

photo ID. A parent living too far away to make his or her request in person may do so with

the assistance of a Notary. See the office manager for details. Before the information or

records can be released, the office manager must get confirmation from both parents that

there is no court order specifically revoking the parent’s rights regarding access to records

or information. As noted in the policy above, requests for specific records will handled in

keeping with Statute 456.057(4).

All reasonable efforts are made to respond to such requests in a timely manner.

Reports of examination and treatment should adhere to our summary format. Please follow

the sample Clinical Summary in the Appendix of this document.

69. Subpoena to request BTI records. All subpoenas come to the BTI office.

All subpoenas are submitted to NSU’s legal advisors for review.

Only in response to a subpoena issued by a judge or judge magistrate should a BTI

practicum student or intern make a court appearance as an expert witness (see below). If

you receive an informal request to serve as an expert witness, contact the BTI director,

who will help you politely decline.

If your client’s file is subpoenaed, the BTI office will notify you and your supervisor. If

the notes in question contain information about couple or family sessions, BTI cannot

release the information until a court order requires us to do so, or until all participants over

18 have signed an authorization.


If there is a subpoena to appear in court, BTI will need to comply. We will need either a

court order or authorization from your clients before any clinical information can be

divulged. BTI staff will assist you and your supervisor with the handling of all legal

situations.

DVDs and Digital Recordings

70. All DVDs, BTI flash drives and digital recordings are the property of the Brief

Therapy Institute and must not be removed without signed authorization from the

director. See the office staff for the necessary form.

71. Master’s and doctoral students working in practicum must label their DVD’s (see below)

after the disc has been finalized. Discs are to be placed in the black practicum bag at the end

of each practicum session and returned to the BTI office. The DVDs will be placed in your

practicum’s file folder in the filing cabinet.

72. If you need a blank DVD, ask your supervisor or the front office staff.

73. DVD Storage. Once you have recorded a session, you must give the DVD to your

supervisor or the front-office staff before you leave the premises. It will be stored in the front

office. Label all DVDs. (see insert). If the front office is locked, put the DVD through the

mail slot in the BTI front-office door.

74. If you wish to use segments from a DVD for a clinical exam and/or professional presentation

your clients have had to completely fill out two forms: the AUTHORIZATIONFOR USE OR

DISCLOSURE OF INFORMATION FOR INSIDE EDUCATIONAL AND RELATED

PURPOSES form and AUTHORIZATIONFOR USE OR DISCLOSURE OF INFORMATION

FOR OUTSIDE EDUCATIONAL AND RELATED PURPOSES which can be found on the

right hand side of the client file.

These forms were distributed with the Family Therapy Agreement.to the clients prior to

their first session.

If client originally declined permission, you may request they reconsider at a later date if

you determine that you want to use the materials for presentations.

The appropriate form must be signed for presentation use.

Seville/McKenzie

2010-200 4/9/2000

Gordon

Master’s or

Doctoral

Practicum

Date of

Session

Client’s Last

Name

Therapist’s First

& Last Name

Client Case

Number

Practicum

Supervisor


75. Disposal of Recorded Information. DVDs for master’s students are shredded after each

term.

76. Removal of any recorded information without the appropriate authorization is

considered a privacy breach; a violation on HIPAA Policy. Based on NSU’s policy, a

Privacy Incident Form will be generated and forwarded to the university’s Compliance

Office. The director and chair of your program will be notified about this breach.

Clinical Portfolio

77. Doctoral students preparing for their clinical portfolio or other clinical presentations must

contact the office manager about how to initiate this process and to get a copy of the

Clinical Portfolio Policy and Process document

Students preparing for the clinical portfolio will need their clients to have signed the

Authorization for Use or Disclosure of Information for Inside Educational and

Related Purposes.

DVDs and flash drives must be signed-in and signed-out of the clinic office.

Clinical portfolios take a total of one semester to prepare and complete.

Students must book time to review their case file and recorded sessions. This will only be

done by scheduled appointments using the appropriate appointment form for room

reservation.

Once you have determined the clips of client(s) sessions you wish to use in your

presentation, you must record the clip times for your reference.

BTI will supply encrypted flash drives to each student preparing for their clinical portfolio.

This flash drive will be used in the BTI Apple computers set aside for this project and will

house your complete presentation (PowerPoint & video clips).

The Apple computers used for editing can be reserved with the BTI Office Manager and

can be used in any observation room or the editing suite.

As per HIPAA Policy, all clinical portfolio DVDs and flash drives with digital files

copied from DVDs are the property of BTI. You may not make or keep copies of any BTI

clinical DVDs or files or any presentations derived from these sources.

Following the successful completion of your exam, your edited encrypted flash drives (and

all session DVDs) must be returned to the BTI office, where they will be stored for your

future use (assuming you have proper releases signed).

After you have completed your clinical portfolio and wish to present your case in any

classroom situation or outside presentation, you must email the BTI Office manager for

permission. In the email, please include date, time, instructor, and building which you will

be presenting.

Supervision and Seeing Clients Outside of Practicum

78. Authorization for Doctoral Students to See Clients Outside of Practicum. (For students

who have completed three doctoral practicums).You are required to receive behind-the-

mirror supervision unless you are a doctoral student who has been approved by your

supervisor and the BTI director to see cases on your own. Be sure your supervisor signs and

submits the form: Authorization for Doctoral Students to See Clients Outside of

Practicum at least two weeks in advance of your scheduling any cases, as the BTI director

will need to review and sign the form, too.

79. Supervision. All therapists seeing clients outside of practicum must attend supervision

meetings with a BTI supervisor, a supervisor candidate, or the BTI director. Please consult

with the office staff regarding scheduling.

80. Supervision is required for every 15 hours of one-on-one therapy.


81. If you fail to seek out and obtain regular supervision for your outside-of-practicum cases,

your approval to see cases on your own will be revoked and your cases will be transferred to

another therapist.

82. If you receive supervision from doctoral-student supervisor candidates, you will not be able

to count this time toward your supervision requirements for graduation; however, given the

amount of supervision you receive from the faculty during your program, you will not need

this time to graduate. You can, of course, count any client contact hours you get while

working with supervisor candidates.

Research and Testing

83. Written Approval. No research involving current or former BTI clients, therapists,

supervisors, or staff may be conducted without the BTI director’s written approval. Such

approval must be obtained twice:

At the planning stage.

Before the proposal has been defended and/or before an IRB submission has been made.

Researchers may not contact potential research participants without both approvals in hand.

84. No testing can be conducted and no assessment devices administered at BTI without the BTI

director’s written approval. Any testing involving BTI clients or their families must be

carried out at BTI and supervised by a DFT faculty member.

Reporting Abuse, Neglect, or Abandonment

85. Florida Statutes. Chapters 39 and 415 of the Florida Statutes mandate mental health

professionals to report to the Abuse Hotline (1-800-96-ABUSE) any knowledge or suspicion

of abuse, neglect, exploitation, abandonment of children or vulnerable adults as well as

domestic violence that is witnessed by a child. Witnessing can be defined as auditory, visual,

or inferred, including cases in which the child perceives the aftermath of violence.

Please note that Chapters 39 and 415 of the Florida Statutes can be found in each team

suite in the black binder labeled Crisis Assessment & Emergency Protocol.

A complete copy of the Florida Statutes is available for your review in the BTI office.

86. Reporting. Note that corporal punishment is legal in Florida—parents are allowed to hit

their children. To meet criteria for “abuse,” the hitting needs to be deemed excessive by the

hotline counselor. This determination is made by considering the circumstances and the

details of the hitting—how many times and where the child was struck, the manner of the

hitting and what the child was struck with, and whether he or she sustained any injuries. It is

the hotline counselor’s job, not yours, to determine whether an instance (or a pattern) of

corporal punishment has been excessive. Your job is to report hitting that you suspect is

excessive.

If a client discloses information that you believe may require reporting, contact your

supervisor immediately to discuss the details of the situation. Talk to your supervisor

before talking to the clients about next steps and before the clients leave the building.

87. Reporting Process. If your supervisor and/or the BTI director decides that the situation

warrants a call being made to the Abuse Hotline, follow the procedures listed below and

document, in your case notes, the reporting process and content, as well as any follow-up

activities.

In the observation room, in collaboration with your supervisor and team, write down the

description of the alleged abuse that you heard from the clients. Be specific, using the

language of the clients to detail what allegedly happened during the specific incident(s)

they mentioned.

a. When everyone behind the mirror concurs with the description, bring it with you

when you rejoin the clients in the therapy room.


b. Also bring a pen and some paper with you, as you will be writing down information

during your telephone call to the Abuse Hotline.

c. If your supervisor and/or you believe that the supervisor should take the lead in the

reporting process, then participate in whatever way the two of you deem

appropriate.

Tell your clients that we are legally obligated to report to the Abuse Hotline the details of

what happened, and read to them the description that you and the team generated.

a. Ask if the description accurately conveys what they told you.

b. Do not change the description except to add missing details or correct the facts.

Explain that you will now be calling the Abuse Hotline from the therapy room and that

after you have finished making the report, you will, if they wish, give them the opportunity

to make any concluding comments to the hotline counselor.

Dial the Abuse Hotline number (1-800-96ABUSE, or 1-800-962-2873) and make your

way through the menu items. Be prepared to stay on hold for as long as it takes to get

through. When the counselor comes on the line, tell him or her who you are and where you

are calling from.

Mental health professionals making a report are required by law to give their names to the

Hotline counselor.

Ask the counselor for his/her name and ID number, and write this information down, as

you must include it in your case-note documentation.

Read your written description of the alleged abuse, and when you are finished, write down

what the counselor tells you, including the status of the report.

Reconfirm the counselor’s name and ID, and ask if he or she requires any additional

information from you. If not, and if your clients would like to speak with him or her, alert

the counselor of this and hand the phone to them.

Once the call is complete, talk with the clients, processing their experience and answering

their questions. If the hotline counselor informs you that BSO will be investigating, let

your clients know that you, with the necessary release-of-information form signed, will be

willing to speak to the investigator and/or the subsequent case-worker.

If appropriate, have the clients sign the Authorization for Use or Disclosure of

Information form and conclude the session.

Safety and Emergencies

88. Alert the BTI staff in the front office.

Call 911, and, in the event of a fire, pull the nearest fire alarm.

When you call 911, NOVALERT sees it on their switchboard. They will contact you,

while you on the phone with 911.

There are emergency buttons in each observation room in case of an emergency arises

during a therapy session.

89. Child Safety: Children under 12 cannot be left alone in the waiting area. If you are not

going to include the family’s children in your session, you must ensure that the parents make

appropriate arrangements for babysitting. If circumstances require that children leave the

therapy room during a session, two members of your team must stay with them until they are

reunited with their parents. Call the front office to see if a therapy room is available, if not

the waiting area will suffice. There are children’s games and materials available in the BTI

office.

90. Emergency Medical Situation: If someone at BTI is in need of emergency medical

attention, if there is a fire, or if you need a police officer, take the following steps:

a) Alert an on-site supervisor.

b) Alert the BTI staff in the front office and to contact the BTI director.


Further information can be found in the Campus Safety brochures, located in the front office.

91. In Case of Danger: If you are having trouble with a client situation, contact the BTI office

immediately. They will locate an on-site faculty supervisor. If the situation presents a danger

to someone, if it involves reporting abuse or neglect, or if it involves the courts or legal

system, then you and/or the supervisor should ask the BTI staff to contact the BTI director,

Arlene Brett Gordon, at 954-292-8733.

Risk of Self-Harm

92. Relational Suicide Assessment (RSA). If you have reason to suspect that your client may

be suicidal, use the Crisis Assessment Form, available in the front office to help you

conduct a thorough and balanced assessment.

Use the Backpocket RSA, Risk & Resource Interview Guide including the Safety Plan

Brainstorming Guide, as your reference for this assessment. This information can be

found in a binder located in each BTI observation room or in the BTI office.

Please review the demonstration of a session using the RSA prepared by Dr. Douglas

Flemons at

https://sharkmedia.nova.edu/media/Dept.+Family+Therapy+Training/1_lnp3x86h .

This can be reviewed during either practicum or independently. Please speak to the office

manager about signing this DVD out.

93. Involuntary Hospitalization (Baker Act). If you are concerned that your client may need to

be involuntarily hospitalized, follow this protocol:

Consult with your supervisor behind the mirror.

Refer to the Emergency Protocol binder found in each observation room.

If you do not have a behind-the-mirror supervisor, have a colleague locate one in the

building, interrupting his or her practicum if necessary. Do not leave your client alone—if

you do not have a colleague behind the mirror, call the front desk and say something like

the following to the receptionist (calmly): “I am with my client, and we’ve been talking

about ways to ensure that s/he can stay safe. Could you have a supervisor join us and help

us explore further safety possibilities?” This will cue the receptionist that you need a

supervisor immediately for a risk and resource assessment.

If, after the supervisor has conducted a suicide assessment, at least one of you believes the

client needs to be involuntarily hospitalized, contact the BTI director and consult over the

phone.

If, in consultation with the supervisor and the BTI director, it is decided that it is not

necessary to hospitalize the client involuntarily, develop a safety plan with the supervisor

and the client. Documentation in the case note should specify the details of the safety plan

and clarify the several choices/steps worked out to ensure this safety. Clarify that

hospitalization was offered as a possibility should the client’s circumstances, state of mind,

or feelings of safety deteriorate at some point in the future.

The note detailing the crisis evaluation should include not only relevant information you

have observed and obtained, as well as therapeutic steps you took; it should also clarify

what is not the case (e.g., “The client stated that despite his sense of hopelessness, he does

not consider suicide an option. He owns no weapons, he has no plan, and he has engaged

in no self-injurious behavior. As part of a safety plan that we agreed on, voluntary

hospitalization will be pursued in the event that ...”).



If, in consultation with the supervisor and the BTI director, it is decided that it is necessary

to hospitalize the client involuntarily, then you should stay with the client while the office

manager (or receptionist) calls 911 and the supervisor initiates the Baker Act paperwork

(Certificate of Professional Initiating Involuntary Examination—see below).

The 911 operator may want a description of the client, in case he or she leaves the building

before the police arrive. Thus, give the office manager the following information about

your client’s appearance: age, height, weight, detailed description of clothing.

When the office manager calls 911, she or she should say, “My name is _____________

and I’m calling from the Brief Therapy Institute in the Maltz Building on the NSU campus.

We have a client who needs to be transported by the BSO Baker Act team to Memorial

Regional Hospital, and we need a Davie police officer to stand by until the Baker Act team

arrives.”

Once the officer manager hangs up, Public Safety will call immediately to find out why

911 was called. After the office manager explains the situation, Public Safety will send an

officer to stand by and another officer to escort the police to the clinic.

The office manager calls the BSO Baker Act transportation unit at 954-321-4318 (BSO

dispatch can also be called at 954-765-4321; they will then call the transportation unit),

informing them that we need them to come and transport a suicidal client to Memorial

Regional Hospital.

The supervisor fills out the Certificate of Professional Initiating Involuntary

Examination as follows:

o Top of page 1: Fill in client’s name, the time of your assessment, and that you

examined them in Broward county.

o Do not fill in the blank on this line: “OR I am a physician who has determined . . .”

o List your professional license number.

o If you are an LMFT , check the box “Licensed Marriage and Family Therapist”.

o Section I: CRITERIA: Use the DSM in the front office to correctly list the diagnosis

and the associated DSM code.

Check either or both of the following boxes, depending on the client’s

response:

A. Person has refused voluntary examination after conscientious

explanation of the purpose of examination

B. Person is unable to determine for himself/herself whether

examination is necessary

Check either or both A and B, depending on what you know about the client’s

situation, and under B, check either or both “self” and “others.”

A. Without care and treatment the person is likely to suffer from

neglect or refuse to care for himself/herself. . . .

B. There is substantial likelihood that without care or treatment the

person will cause serious bodily harm to (check one or both):

self others

in the near future, as evidenced by recent behaviors

o Section II: SUPPORTING EVIDENCE: Describe the information you obtained from

conducting your assessment—both the content of your concerns and the process of

the interview. Be succinct and specific.

o Section III: OTHER INFORMATION: If you also talked with a family member or

friend, include information from them here. Also list relevant information you have

from other mental health professionals, medical records, etc.

o Section IV: NON-COMPLIANCE WITH INVOLUNTARY OUTPATIENT PLACEMENT

ORDER: Leave this blank.


o Section V: INFORMATION FOR LAW ENFORCEMENT: Fill this in.

o Section VI: SIGNATURE: Check “yes” only if you have taken the day-long Baker

Act training offered through the University of South Florida.

Make two copies of the original, signed form. Place the original in a sealed envelop and

write “Memorial Regional Hospital, Psychiatric Assessment Center” on the front. Place

one copy of the form in the chart and give the other to whoever transports the client.

If appropriate, ask the client to sign our Authorization for Use or Disclosure of

Information, for the receiving facility (Memorial Regional Hospital, Psychiatric

Assessment Center), as well as for relevant family members and/or friends who are part of

the client’s support system. If the client refuses to sign, advise the client that you will not

be able to communicate with anyone including the hospital about their current situation.

The police officer and the Public Safety officer will stand by while you await the BSO

team.

If the BSO team will be delayed or the client is agitated, the police may decide to transport

the client to Memorial Regional themselves. If this happens, inform your client in advance

that it is Davie Police policy to handcuff anyone they transport to the hospital. This does

not mean that he or she has been arrested.

If the BSO team is able to transport the client, they will arrive in plain clothes and they will

not handcuff the client unless he or she is agitated.

Once the client has left for the hospital, you and the supervisor, in consultation with the

BTI director, determine whether anyone on the Release of Information form should be

notified.

If the client has signed the Authorization for Use or Disclosure of Information, the

supervisor calls the Memorial Regional Hospital Psychiatric Assessment Center at 954-

986-6310 (main number for the hospital is 954-987-2000) and tells them that a client of

ours is en route to their center for an evaluation for involuntary admission. The supervisor

provides some background information for them to use in their assessment.

Complete your case note, detailing what happened and why you made the clinical choices

you did.

Follow up with your supervisor and the BTI director.


Family Therapy Clinic at the Brief Therapy Institute

Documents

1. Policies and Procedures

a. The description of the professional practices that best protect clients, therapists and the

Family Therapy Clinic at the Brief Therapy Institute.

b. Updated regularly to address any and all needs that fulfill the above goal.

c. Questions can be addressed to BTI staff including the director.

2. Disclosure of Guiding Principle

a. A statement which reflects the core values and beliefs in our commitment to our students

and our clients.

b. Document must be signed by each therapist at the beginning of each term.

3. BTI Phone Intake Form

a. Set of questions used by BTI’s GA during initial phone contact with perspective clients.

b. Provides the therapists with information about the case prior to the first session.

4. BTI Client Information Form

a. Demographic information generated by client prior to initial session.

b. Located in file when client file is generated.

5. Family Therapy Agreement

a. Client (over 18 years of age) contract initiating therapy. Includes:

i. Florida Statutes with regards to reporting abuse, neglect, self harm, domestic

violence and/or court ordered subpoenas.

ii. Confidentiality

iii. Educational environment

b. All attending parties must sign this document prior to initiating therapy session.

6. Authorization for Audio/Visual Recording and Observation for Supervisory Purposes:

Mandatory.

a. Must be signed by all clients over 18 prior to initiating therapy.

b. This document authorizes either live or video supervision.

7. Authorization for Use or Disclosure of Information for Inside Educational and Related

a. Clients sign to authorize that the video materials may be shown in classrooms within the

Maltz Building.

b. This is not mandatory, but preferred.

8. Authorization for Use or Disclosure of Information for Outside Educational and Related

Purposes:

a. Clients sign this document to authorize that the video materials of their session may be

used for educational purposes such as conferences, journal articles, and books.

b. This is not mandatory, but preferred.

9. Treatment Consent Affidavit

a. Generated from BTI office staff

b. Document for parents with children under 18 in need of services

c. Used if one parent is not able to sign Therapy Agreement (must be notarized).

10. Progress Notes

a. Completed after each session or meeting with client and/or permitted third parties

b. Record no shows and cancellations

c. Three formats: initial, ongoing, closing sessions


11. Phone/Contact Log

a. An on-going blue document to record phone contact with clients and/or permitted third

parties

b. Document must be signed by therapist at the completion of each entry.

c. Document must be signed by therapist and supervisor at completion of each page.

12. Authorization for Use or Disclosure of Information

a. Required permission to contact any third party (i.e. lawyers, case managers etc.)

13. Practicum Appointment Form (day or evening)

a. Appointment scheduling form to be completed at the end of each practicum session by the

practicum supervisor with assistance of the team.

14. Fee Change Request

a. Document to reduce client’s session fee with explanation.

15. Session Evaluation

a. Document distributed by BTI office staff at the end of each therapy session.

b. This document is to be deposited by client directly into the “Suggestion Box” placed

outside the BTI window.

16. Clinical Summary Template

a. Template for letter generated by the BTI office in lieu of request for records.

b. Sample of Clinical Summary can be found on page 27 on this manual.

17. Clinical Letters (samples)

a. Guidelines for letters written by therapist/supervisor as requested by client or third party.

b. Samples are available on pages 24-26 and in each practicum’s black binder.

18. Client Transfer/Transition Form

a. Document to track transfer or transition of clinic cases

b. Can be generated from practicums or independent clinicians

c. Keeps BTI informed of status of case.

19. Crisis Assessment Form and the Relational Suicide Assessment (RSA): The Backpocket RSA

a. Guide for use with client who might be suicidal

b. Located in each observation room and in the BTI office.

20. Certificate of Professional Initiating Involuntary Examination

a. Baker Act Form for involuntary hospitalization

b. Initiated by supervisor after contacting the BTI director.

For Doctoral Students

21. Authorization for Doctoral Students to See Clients Outside of Practicum:

a. Permits doctoral students who have completed three or more practicum to see clients

independent of practicum.

b. Supervision must be arranged with the clinical director.

22. Authorization for Use or Disclosure of Information For Educational and Related Purposes

a. For doctoral students and faculty use of protected clinical information for educational

purposes.

23. Appointment Schedule Form (outside of practicum format)

a. Appointment scheduling form to be completed by the Thursday of each week for the

upcoming week by students working independently of practicum.

b. Completed form should be place in mail slot labeled “Intake”.


For Faculty

24. Faculty Practicum Checklist

a. Document used by faculty practicum supervisors to record information either gathered or

covered during practicum

25. Authorization for Use or Disclosure of Information For Educational and Related Purposes

a. For doctoral students and faculty use of protected clinical information for educational

purposes.

Recording Hours

26. Client Contact Hour Sheet

a. Record of contact hours provided

b. Used for internal, external and doctoral internship

c. Academic component (see Internship Coordinator)

27. Supervision Hours Sheet (academic component- see Internship Coordinator)

a. Record of supervision hours received

b. Used for internal, external and doctoral internship

c. Academic component (see Internship Coordinator)


CASE FILE PAPERWORK FORMAT

LEFT SIDE OF FILE

RIGHT SIDE OF FILE

From top to bottom:

Receipts (when generated)

BTI Client Information Form

Fee Change Request Form

Release(s) of Information

Correspondence

Therapy Agreement

BTI Phone Intake

From top to bottom:

*Active Case Notes Only*

*Phone/Contact Log*

(Phone Log should be placed in

chronological order amongst case

notes)


(Month) (Day), 2012

Broward County Courthouse

Broward Sheriff’s Office

Department of Community Control

Day Reporting and Reentry Division

Attn: (Probation Officer Name)

(Street Number) (Street)

(City) (State) (Zip Code)

Re: (Client’s Full Name)

Case #: (Case Number on referral form)

Dear (Probation Officer Name),

(Client’s full name) is a drug court-mandated client at The Brief Therapy Institute, located at Nova Southeastern

University. (Client’s full name) has attended (# of sessions) sessions on (List the dates of each session the client

attended) 2010.

In the course of therapy, (Client’s full name) has been working towards their primary goal: (State client’s goals

even if it is just to complete the mandated sessions). To date, (Client’s full name) has reported making progress on

his goal by (state how the client has completed their goals). Additionally, (Add any other relevant information

regarding the client’s progress at BTI).

During therapy, (Client’s full name) completed his therapeutic tasks and cooperated with all discussions. (Client’s

full name) stated (Add any final remarks the client may have noted relevant to their progress). If you have any

further questions, please do not hesitate to contact us at 954-262-3030.

Sincerely,

(Therapist Name) (Credentials)

Graduate Family Therapist

(Supervisor Name) (Credentials)

Supervisor

Sample Letter:

Drug Court


November 19, 2010

ChildNet

Attn: TTTTTT

313 North State Road 7

Plantation, FL 33317

Dear TTTTT,

Mrs. XXXXX is currently a client at Nova Southeastern University’s Brief Therapy Institute. She came

in for six sessions on the following dates: June 12, June 19, June 26, July 24, September 13, and October

10, 2008.

Appointments were also scheduled for four other additional sessions on July 3, August 9, August 20, and

August 27, 2008 but these appointments were cancelled due to therapist unavailability or client’s inability

to find transportation to our clinic.

During our sessions, we discussed ways in which XXXXX can prepare for the return of her daughter and

what she can do to establish a stable and safe home for her child. XXXXX discussed being aware of the

challenges but also what she needs to do to move in a positive direction. She also discussed completing

the parenting classes required by ChildNet as part of her case plan. During our sessions we talked about

what she had learnt in the groups and how she would apply those once her daughter was in the home.

XXXXX has been an active participant during each session. XXXXX stated that she intends to continue

therapy for herself. She will call the Brief Therapy Institute to schedule her next appointment.

Sincerely,

HHHHH

Family Therapy Graduate Student

TTTTTT

Supervisor

Sample Letter:

ChildNet


March 2, 2010

Broward County Public Schools

YYYYY High School

Attn: XXXXXX

5050 Wiles Road

Coconut Creek, FL 33073

Dear XXXXX,

Per the request of CCCCC, this letter is to confirm that PPPPP and his mother, OOOOO, are

clients at The Brief Therapy Institute at Nova Southeastern University. The family has

attended three sessions on the following dates 2/13/2010, 2/20/2010, 2/27/2010. They have presented themselves to

be attentive, cooperative, and responsive clients.

Since meeting with the family, we have discussed his personal, educational, and family goals. OOOOO has

expressed his desires to continue his education so that he can enroll in college upon

graduating. They have been working towards their goals on a weekly basis and we have

noticed considerable improvements.

Sincerely,

RRRRR

Graduate Family Therapy Intern

ZZZZZZ

Supervisor

Sample Letter:

School


Nova Southeastern University

Brief Therapy Institute

3100 College Avenue

Ft. Lauderdale, FL 33314

(954)262-3030

(954)262-3978 Fax

Clinical Summary

Client Name:

Address:

DOB:

Phone:

Date of Initial Contact:

Presenting Problem: [Take this information off the Phone Screening Form]

Dates of Service: [List each date of service]

Therapist: [Name], [Degree], Family Therapy Graduate Student

Supervisor: [Name], [Degree]

Case Number: [Obtain from file]

Notes: During the [# of sessions] appointments that [Name of client(s)] attended at the Brief Therapy

Institute, [he/she/they] worked on the following issues: [(a) X; (b) Y; and (c) Z]. [Name of Therapist]

offered several suggestions for how change in these issues could be addressed and implemented: [(a) U;

(b) V; and (c) W]. By the last session, [Name of Client(s)] had reported that [description of change or no

change]. [Name of Therapist] noticed [description of any relevant changes or absence of changes in the

issues, the client(s), and/or the circumstances], and thus [s/he] closed the case on [date of closure]. [Name

of Client(s)] [was/were] provided with contact information for [Drs. B and/or C and/or D] and encouraged

to call [him/her/them] within [time frame given to client] to arrange for [continued/follow-up treatment].

[Name of Client(s)] [was/were] also invited to call BTI again in the future, should [he/she/they] wish to be

seen again for therapy.

Status: Case Closed

Policies and Procedures 2017-2018

Documents

Transcript of Policies and Procedures 2017-2018